During the Northern Ireland conflict, writes Ruth Duffy in the introduction to Healthcare and the Troubles, ‘around 40,000 individuals were injured’. Their treatment and care was the responsibility of the Northern Ireland health service, and it is the ability of the service ‘to cope, and the experiences of those working within it’ (1) which forms the focus of her recent monograph.

Whilst this is not the first scholarly contribution to explore the intersections of conflict with healthcare provision in the region, it is perhaps the most meticulously researched and ambitiously wide-ranging. Chapters cover an impressive breadth of topics, including the state of pre-Troubles health and healthcare; the problems created by violent division for medical neutrality; the lived experiences of medical professionals working in hospitals, community and carceral contexts; the practical pressures conflict placed upon the National Health Service, and the enduring impacts of all of this within the ‘post-conflict’ era.

One of the strengths of Duffy’s contribution is her use of twenty-nine new oral history interviews with doctors, nurses, community healthcare workers and hospital administrators as a basis for the study. This material provides often candid insights into the pressures and quandaries faced by medical staff involved in front-line care, whilst avoiding a reliance only on the experiences of those easily traced within the written historical record. Duffy’s interviewees speak openly of their efforts to continue their work and to maintain neutrality amidst the heightening tensions of the Troubles. They also provide unique insights into the dangers staff faced in continuing their work as care practitioners during a period of violent conflict. Nurses speak of their experience of the stationing of security forces in local hospitals, GPs of their efforts to travel to see patients in areas of heightened paramilitary activity and practitioners across different contexts of their tendency to underplay their own need for support in continuously encountering the human costs of conflict. Duffy’s analysis is at its most compelling when it actively draws upon and engages with these interviews. There are, by contrast, some sections of the book where the interviews are used somewhat sparingly, and these might have been further enriched by more sustained engagement with the voices of her participants.

Duffy does not shy away from engaging with difficult and controversial topics, and one of the most effective dimensions of her analysis addresses how the politicisation of healthcare during the conflict produced new and often profound ethical dilemmas for staff and practitioners. She devotes an entire chapter (chapter 3) to the response of healthcare workers to ‘issues around detention and interrogation centres and allegations of torture and inhumane treatment, and the use of riot control agents’ (16). She dedicates another to the provision and limitations of medical care within prisons (chapter 4), including treatment of those engaged in hunger strikes and dirty protests. Some of this material makes for difficult and emotive reading, particularly as Duffy addresses the complex issue of how different practitioners chose either to speak out or to remain silent in the face of suspected or evident human rights abuses. Nevertheless, she approaches these topics and the interview material on which they are based with considerable care and sensitivity.

To be sure, the ambitious scope of Duffy’s monograph is challenging. However, it ensures the work stands as a significant contribution not only to the history of healthcare during the Northern Ireland conflict but also to the growing body of literature focused on the everyday impacts of the conflict and its cultural and social consequences for civilian populations. Her study offers a comprehensive and compelling account of how the health service evolved during more than three decades of conflict, one that is both timely and thought provoking.